Specialty Pharmacy Drug List
Specialty Pharmacy Drug List
Specialty Pharmacy Drug List
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
April 2013<br />
<strong>Specialty</strong> <strong>Pharmacy</strong> <strong>Drug</strong> <strong>List</strong><br />
Providing one of the broadest offerings of specialty pharmaceuticals in the industry<br />
If you are a plan member or health care provider, please contact <strong>Specialty</strong> Customer Care toll-free at 1-800-237-2767<br />
or visit www.cvscaremarkspecialtyrx.com.<br />
With nearly 35 years of experience, CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong> provides quality care and service. We have a network of pharmacies which<br />
includes those with Joint Commission and URAC accreditation. The Joint Commission and URAC are nationally-recognized symbols of quality which<br />
reflects an organization’s commitment to meet high standards of quality and safety.<br />
ACROMEGALY<br />
octreotide acetate<br />
(SANDOSTATIN) 1<br />
Sandostatin LAR<br />
Somatuline Depot*<br />
Somavert*<br />
ALCOHOL<br />
DEPENDENCY<br />
Vivitrol<br />
ALLERGIC ASTHMA<br />
Xolair*<br />
ALPHA-1 ANTITRYPSIN<br />
DEFICIENCY<br />
Aralast 2 *<br />
Glassia*<br />
ANEMIA<br />
Aranesp 2<br />
Epogen<br />
Procrit<br />
BOTULINUM<br />
TOXINS<br />
Botox<br />
Dysport<br />
Myobloc<br />
Xeomin*<br />
CONTRACEPTIVES<br />
Implanon*<br />
Mirena*<br />
Nexplanon*<br />
Skyla*<br />
CRYOPYRIN-<br />
ASSOCIATED PERIODIC<br />
SYNDROMES<br />
Arcalyst*<br />
Ilaris*<br />
CYSTIC FIBROSIS<br />
Kalydeco*<br />
Pulmozyme<br />
TOBI*<br />
DUPUYTREN’S<br />
CONTRACTURE<br />
Xiaflex*<br />
GASTROINTESTINAL<br />
DISORDERS-OTHER<br />
Solesta*<br />
GOUT<br />
Krystexxa*<br />
GROWTH HORMONE<br />
& RELATED<br />
DISORDERS<br />
GH Disorders<br />
Genotropin 2<br />
Humatrope<br />
Norditropin 2<br />
Nutropin 2<br />
Omnitrope<br />
Saizen 2<br />
Serostim*<br />
Tev-Tropin<br />
Zorbtive<br />
IGF-1 Deficiency<br />
Increlex*<br />
HEMATOPOIETICS<br />
Mozobil*<br />
Neumega<br />
HEMOPHILIA,<br />
VON WILLEBRAND<br />
DISEASE & RELATED<br />
BLEEDING DISORDERS<br />
Advate<br />
Alphanate<br />
AlphaNine SD<br />
Bebulin 2<br />
BeneFIX<br />
Corifact*<br />
Feiba NF<br />
Feiba VH<br />
Helixate FS<br />
Hemofil M<br />
Humate-P<br />
Koate-DVI<br />
HEMOPHILIA, cont..<br />
Kogenate FS<br />
Monoclate-P<br />
Mononine<br />
NovoSeven 2<br />
Profilnine SD<br />
Proplex T<br />
Recombinate<br />
Refacto<br />
RiaSTAP<br />
Stimate<br />
Wilate<br />
Xyntha 2<br />
HEPATITIS<br />
Baraclude<br />
Epivir HBV 2<br />
Hepsera<br />
Incivek<br />
Infergen<br />
Pegasys 2<br />
PegIntron 2<br />
Rebetol Solution<br />
RibaPak<br />
Ribasphere<br />
RibaTab<br />
ribavirin caps<br />
(REBETOL) 1<br />
ribavirin tabs<br />
(COPEGUS) 1<br />
Tyzeka<br />
Victrelis<br />
Viread<br />
HEREDITARY<br />
ANGIOEDEMA<br />
Berinert*<br />
Cinryze*<br />
Firazyr*<br />
HIV MEDICATIONS<br />
abacavir tab (ZIAGEN) 1,2<br />
Aptivus<br />
Atripla<br />
Complera<br />
Crixivan<br />
didanosine (VIDEX,<br />
VIDEX EC) 1,2<br />
Edurant<br />
Egrifta*<br />
Emtriva<br />
Epzicom<br />
Fuzeon<br />
Intelence<br />
Invirase<br />
Isentress<br />
Kaletra<br />
lamivudine (EPIVIR) 1<br />
lamivudine/zidovudine<br />
(COMBIVIR) 1<br />
Lexiva<br />
nevirapine<br />
(VIRAMUNE) 1,2<br />
Norvir<br />
Prezista<br />
Rescriptor<br />
Retrovir Injectable<br />
Reyataz<br />
Selzentry<br />
stavudine (ZERIT) 1,2<br />
Stribild<br />
Sustiva<br />
Trizivir<br />
Truvada<br />
Videx Solution<br />
Viracept<br />
Viramune XR<br />
Viread<br />
Ziagen Solution<br />
zidovudine (RETROVIR) 1,2<br />
HORMONAL<br />
THERAPIES<br />
Eligard<br />
Firmagon<br />
leuprolide acetate<br />
(LUPRON) 1<br />
Lupron Depot 2<br />
Supprelin LA*<br />
Trelstar 2<br />
Vantas<br />
Viadur<br />
Zoladex<br />
IMMUNE DEFICIENCIES<br />
& RELATED<br />
DISORDERS<br />
Carimune NF<br />
Cytogam<br />
Flebogamma 2<br />
GamaSTAN S/D<br />
Gammagard<br />
Gammagard S/D<br />
Gammaked<br />
Gammaplex*<br />
Gamunex<br />
HepaGam B<br />
Hizentra*<br />
HyperHEP B<br />
HyperRHO S/D<br />
Immune Globulin<br />
MICRhoGAM 2<br />
Nabi-HB<br />
Octagam<br />
Privigen<br />
RhoGAM 2<br />
Rhophylac<br />
Vivaglobin*<br />
WinRho SDF<br />
IMMUNE (IDIOPATHIC)<br />
THROMBOCYTOPENIC<br />
PURPURA<br />
Nplate<br />
Promacta*<br />
Products distributed by CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong>, as well as products covered by a plan member’s prescription or medical benefit plan may change from time to time. In addition, a plan member’s<br />
specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.<br />
©2013 Caremark. All rights reserved. 75-CTC14953c 03252013 <strong>Specialty</strong> <strong>Pharmacy</strong> <strong>Drug</strong> <strong>List</strong>
April 2013<br />
INFECTIOUS DISEASE<br />
Actimmune*<br />
INFERTILITY<br />
Bravelle<br />
Cetrotide<br />
chorionic gonadotropin<br />
(novarel, pregnyl) 1<br />
Follistim AQ<br />
ganirelix acetate 1<br />
Gonal-F 2<br />
Luveris<br />
Menopur<br />
Ovidrel<br />
Repronex<br />
INFLAMMATORY<br />
BOWEL DISEASE<br />
Cimzia<br />
Humira<br />
Remicade<br />
Tysabri*<br />
IRON OVERLOAD<br />
deferoxamine<br />
(DESFERAL) 1<br />
Exjade*<br />
LIPID DISORDERSS<br />
Kynamro*<br />
LYSOSOMAL STORAGE<br />
DISORDERS<br />
Aldurazyme*<br />
Cerezyme*<br />
Cystagon*<br />
Elaprase*<br />
Fabrazyme*<br />
Lumizyme*<br />
Myozyme*<br />
Naglazyme*<br />
VPRIV*<br />
RETINAL DISORDERS ONCOLOGY –<br />
Eylea*<br />
ORAL/TOPICAL<br />
Lucentis*<br />
Afinitor<br />
Macugen*<br />
Bosulif<br />
Ozurdex*<br />
Erivedge*<br />
Retisert*<br />
Gleevec<br />
Visudyne*<br />
Hycamtin*<br />
Inclusig<br />
MOVEMENT<br />
Inlyta*<br />
DISORDERS<br />
Jakafi*<br />
Apokyn*<br />
Nexavar*<br />
Xenazine*<br />
Oforta*<br />
Pomalyst*<br />
MULTIPLE SCLEROSIS Revlimid*<br />
Ampyra*<br />
Sprycel<br />
Aubagio*<br />
Stivarga*<br />
Avonex 2<br />
Sutent<br />
Betaseron<br />
Tarceva<br />
Copaxone<br />
Targretin 2<br />
Extavia<br />
Tasigna<br />
Gilenya<br />
Temodar<br />
Rebif 2<br />
Thalomid<br />
Tysabri*<br />
Tykerb*<br />
Votrient*<br />
NEUTROPENIA<br />
Xalkori*<br />
Leukine<br />
Xeloda<br />
Neulasta<br />
Xtandi*<br />
Neupogen<br />
Zelboraf*<br />
Zolinza<br />
ONCOLOGY –<br />
Zytiga<br />
INJECTABLE 4<br />
Synribo<br />
OSTEOARTHRITIS<br />
Thyrogen*<br />
Euflexxa<br />
Xgeva<br />
Hyalgan<br />
zolendronic acid<br />
Orthovisc<br />
(ZOMETA) 1 Supartz<br />
Synvisc<br />
Synvisc One<br />
OSTEOPOROSIS<br />
Forteo<br />
Prolia<br />
Reclast<br />
PAROXYSMAL<br />
NOCTURNAL<br />
HEMOGLOBINURIA<br />
Soliris*<br />
PHEYLKETONURIA<br />
Kuvan*<br />
PRE-TERM BIRTH<br />
Makena*<br />
PSORIASIS<br />
Amevive<br />
Enbrel<br />
Humira<br />
Remicade<br />
Stelara<br />
PULMONARY<br />
ARTERIAL<br />
HYPERTENSION<br />
Adcirca<br />
epoprostenol sodium* 1<br />
Letairis*<br />
Remodulin*<br />
sildenafil citrate<br />
(REVATIO) 1<br />
Tracleer*<br />
Tyvaso*<br />
Ventavis*<br />
RENAL DISEASE<br />
Sensipar<br />
RESPIRATORY<br />
SYNCYTIAL VIRUS<br />
Synagis<br />
RHEUMATOID<br />
ARTHRITIS<br />
Actemra<br />
Cimzia<br />
Enbrel<br />
Humira<br />
Kineret<br />
Orencia<br />
Remicade<br />
Simponi<br />
Xeljanz<br />
SEIZURE DISORDERS<br />
H. P. Acthar Gel *<br />
Sabril*<br />
SYSTEMIC LUPUS<br />
ERYTHEMATOSUS<br />
Benlysta<br />
TRANSPLANT<br />
CellCept Injectable<br />
CellCept Suspension<br />
cyclosporine<br />
(gengraf, NEORAL,<br />
SANDIMMUNE) 1,2<br />
mycophenolate<br />
mofetil (CellCept) 1,2<br />
Myfortic<br />
Nulojix<br />
Prograf Injectable<br />
Rapamune<br />
tacrolimus<br />
(Prograf) 1,2<br />
Zortress<br />
UREA CYCLE<br />
DISORDERS<br />
Ravicti*<br />
If you are a plan member or health care provider, please contact <strong>Specialty</strong> Customer Care toll-free at<br />
1-800-237-2767 or visit www.cvscaremarkspecialtyrx.com.<br />
1<br />
Lowercase type indicates generic name and availability; lowercase type within parentheses indicates trademark generics listed only when no brand is available; products in all capital letters within parentheses<br />
indicate brand-names of generic products.<br />
2<br />
Multiple dosage formulations and/or injectable devices are available.<br />
3<br />
Includes progesterone injectable and intravaginal products. Does not include oral dosage forms.<br />
4<br />
Call CVS Caremark toll-free at 1-800-237-2767 for specific medications available through CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong>. <strong>List</strong>ing is subject to change.<br />
* Indicates Limited Distribution products distributed by CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong>. Limited Distribution defined as less than 15 pharmacy providers.<br />
Products distributed by CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong>, as well as products covered by a plan member’s prescription or medical benefit plan may change from time to time. In addition, a plan member’s<br />
specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.<br />
©2013 Caremark. All rights reserved. 75-CTC14953c 03252013 <strong>Specialty</strong> <strong>Pharmacy</strong> <strong>Drug</strong> <strong>List</strong>
Change language